Effect of Botulism Antitoxin on Food Borne Botulism Outbreak in Nan Province, Thailand 2006 - ผลการรักษาผู้ป่วยโบทูลิซึม ด้วยยาต้านชีวพิษ ในการระบาดครั้งใหญ่ของจังหวัดน่าน ในปี 2549

บทคัดย่อ

                       During 15 - 26 March 2006, there was a large outbreak of food-borne botulism associated with ingestion of home - canned bamboo shoots at a religious rite in Ban Pluang district, Nan province, Thailand.  In all, 209 patients were reported of which 190 patients were admitted in Nan hospital and 91 patients received antitoxin.  Twenty three of them were transferred to eight more-advanced facilities.In a retrospective descriptive study, a comparison of 68 remaining patients was made between those received antitoxin within 4 days after the onset of the disease and those after 4 days.  The primary outcome was determined by the length of stay in the hospital and the duration of ventilator usage.  Among 68 patients who received antitoxin, the patients were divided into 2 groups, 20 patients who had respiratory failure and the other 48 patients who did not.  It was found that, in respiratory failure group who received antitoxin within 4 days after the onsets (n=11) the lengths of stay were between 10 and 35 days (average 18.54 ), and the duration of ventilator usage between 3 and 33 days (average 12.18 ).  As for the patients who received antitoxin later than 4 days after the onsets (n=9) Their lengths of stay in hospital were between 11 and 43 days (average= 23.35 ), and duration of ventilator usage between 1 and 33 days (average =9.44).  There was statistical significance in the difference of the length of stay in the hospital (p-value 0.048) between the two group, however no difference between duration of ventilator usage was established (p-value 0.354).  In the group of patients who did not have respiratory failure, the result showed that patients who receive antitoxin within 4 days after the onsets (n=20) had shorter length of stay in the hospital, 1-16 days (average 8.00), than the patients who received antitoxin later than the 4 days (n=28), 3-29 days (average 10.8 ).  However there was no statistical significance in the difference in length of stay within this group (p-value 0.06).  It was concluded that the timing of receiving antitoxin determined favorite outcomes.

Key words:      botulism, antitoxin